Cardiosurgical Interventions Research Articles

The influence of various technologies for the use of gaseous nitric oxide on the functional and morphological state of the lungs, markers of myocardial damage and clinical outcomes in cardiosurgical interventions with cardiopulmonary bypass

The aim of the study was to evaluate the impact of various technologies for the use of gaseous nitric oxide on the state of the lungs and heart during heart valve surgery under cardiopulmonary bypass (CPB).Methods. The study included 93 patients of both sexes. All patients underwent heart valve surgery and combined surgical interventions under CPB. The patients were divided into 4 groups. Group 1 (control, n = 30) used the standard protocol for anesthetic and perfusion management. Group 2 (n = 30) received inhalation of nitric oxide (20 ppm) within 3 days before surgery, as well as before and after CPB. Group 3 (n = 30) inhaled nitric oxide (40 ppm) throughout surgery with the medication delivered through inspiratory part of the ventilator and combined with perfusion of the pulmonary artery and reduced volume ventilation during CPB. Group 4 (n = 33) received nitric oxide (40 ppm) via oxygenator of the heart-lung machine. We assessed changes in the functional parameters of the lungs at different phases of surgery, performed a morphological examination of the lungs in the initial phase (before CPB), at the peak of ischemia, and after reperfusion. The state of the myocardium after surgery was assessed by troponin I (cTnI) activity at the beginning of the operation, after transfer to the ICU, at 12, 24 and 48 hours after the surgery. Myocardial damage index (MDI) was calculated according to the following formula: MDI = TnIlate / TnIearly. The clinical outcomes of the surgeries were evaluated.Results. There were no statistically significant differences in the functional state of the lungs with various options for inhalation delivery and administration via the CPB circuit. The most intact indicators of the functional state of the lungs were seen in patients of Group 3 who received inhaled nitric oxide throughout surgery and combined mechanical ventilation with the addition of nitric oxide and perfusion of the pulmonary artery during CPB. Morphological examination of the lungs showed that inhalation of nitric oxide before CPB does not prevent the development of morphological disorders. Morphological changes found in Group 3 were the smallest. The supply of nitric oxide into the CPB circuit statistically significantly improved the restoration of pulmonary blood flow during reperfusion. The cTnI level statistically significantly increased in all groups of patients, however, it was statistically significantly lower in Groups 2, 3, and 4 compared with Group 1 at the end of surgery, in Groups 3 and 4 compared with Groups 1 and 2 after 12 and 24 hours, and in Group 3 after 48 hours. The most favorable changes in the MDI were seen in Group 3; statistically significantly lower MDI was registered 12 and 48 hours after surgery in this group compared with Groups 1, 2, and 4. A lower complication rate, a shorter duration of ventilation and stay in the ICU were observed in Groups 3 and 4.Conclusion. Nitric oxide has a protective effect on the lungs and heart when used during anesthesia and cardiopulmonary bypass in heart valve surgery. It preserves the lung function and morphology and statistically significantly reduces cTnI level and myocardial damage index in the postoperative period. The extent of the protective effect depends on the nitric oxide exposure time and is most pronounced when nitric oxide is used throughout the surgery, including during CPB.

Personalization of therapy of psychopathological complications of cardiac surgery in artificial circulation conditions

IntroductionThe study of the clinical and phenomenological features of psychopathological complications of cardiac surgery (CS) in artificial circulation conditions (ACC), the development of modern approaches to early diagnosis and prognosis of psychopathology is an effective way to solve this problem has valid medical and social significance.ObjectivesTo increase the effectiveness of prevention of psychopathological disorders in cardiosurgical interventions based on personalization of their correction.MethodsThe examination included the use of socio-demographic, instrumental, biochemical, clinical-psychopathological, psychometric, and statistical methods.ResultsThe study sample consisted of 700 patients who were treated by CS in ACC at the SI “Heart Institute of the MH of Ukraine”.It was found out that the most common complication is postsurgeon cognitive dysfunction (PCD) (72.0% of patients), postsurgeon encephalopathy (PE) (31.0%) is less common, and cerebral infarction (CI) is the least common (12.2%).It was revealed that the core psychopathological symptoms associated with CS are cognitive disorders (72.0% of the examined) and affective symptoms, represented by depressive (38.1%) and anxiety (33.9%) manifestations of mild and moderate expressiveness, and auxiliary constructs – dyssomnic (29.7%), asthenic (17.9%) and somatovegetative (9.0%) disorders. The highest prevalence of psychopathological symptoms was found in patients with CI, somewhat less in patients with PE, and the lowest in patients with PCD.Signs of mild depressive disorder were found in patients who underwent CS in ACC, elevated levels of adynamic depression indicators, depression with fear and agitated depression, as well as increased levels of anxiety: the average level of anxiety, mental and somatic anxiety. The indicators of expressiveness of depression and anxiety in patients with CI turned out to be the highest, in patients with PE – lower, and in patients with PCD – the lowest.We proposed a mathematical model for predicting the development of psychosocial maladjustment (PM) in patients who have undergone CS in ACC. It is based on a comprehensive assessment of three key vectors that can have a mutually potentiating pathogenetically related effect on the course of the formation of PM: surgical, neurological, and psychopathological. A complex of diagnostic, corrective and preventive measures for each of the risk groups has been developed.ConclusionsVerification of the proposed model on a representative sample of patients confirmed its high predictive ability and reliability in use.Disclosure of InterestNone Declared

Perfusión dirigida por objetivos: práctica actual en técnicas de circulación extracorpórea

Extracorporeal circulation (ECC) is an essential component of cardiac surgery since it allows life support to be maintained during the induced cardiac arrest necessary to perform cardiosurgical interventions. However, CPB presents adverse effects at a local and systemic level because its components produce alterations at the macro- and microcirculation levels, potentially leading to hypoperfusion. The goal-directed perfusion (GDP) technique seeks to personalize hemodynamic management according to predefined goals, thereby optimizing tissue oxygenation and perfusion during CPB. This implies constant monitoring of key parameters, to make real-time changes to perfusion strategies. Over the past 10 years, the benefits of using GDP have been explored and its superiority over the traditional approach visualized. The objective of this article is to describe GDP practice in monitoring during CPB. We will focus on the existing variables monitored under the GDP concept, applying and manipulating them to optimize tissue perfusion in real-time.

Patient-Reported Postoperative Neuropsychological Deterioration After Heart Valve Replacement and Coronary Artery Bypass Grafting

BackgroundPostoperative cognitive decline (POCD) after cardiosurgical interventions are well described through objective psychometric tests. However, a patient’s subjective perception is essential to clinical assessment and quality of life. This study systematically evaluated patient-reported POCD between subjects undergoing coronary artery bypass grafting and heart valve replacement. MethodsThis study was a multicentre, prospective questionnaire survey conducted at the cardiac surgery departments at the Kerckhoff Clinic in Bad Nauheim and the University Hospital in Giessen, Germany. We included patients undergoing elective coronary artery bypass grafting (CABG), aortic valve replacement (AVR), mitral valve replacement or reconstruction (MVR), and combined surgery (CABG + valve replacement [VR]) with extracorporeal circulation. The Hospital Anxiety and Depression Scale, the Cognitive Failures Questionnaire (CFQ) for Self-assessment (CFQ-S), and the external assessment (CFQ-foreign [F]) were completed preoperatively, as well as at 3 and 12 months postoperatively. ResultsA total of 491 patients were available for analyses (CABG = 182, AVR = 134, MVR = 93, CABG + VR = 82). POCD and postoperative depression increase (PODI) were observed for each surgical procedure. (At the 3-month follow-up: CFQ-S [CABG = 7.1%, AVR = 3.7%, MVR = 9.7%, CABG + VR = 9.8%]; CFQ-F [CABG = 9.9%, AVR = 9.7%, MVR = 9.7%, CABG + VR = 15.9%]; PODI [CABG = 7.7%, AVR = 9.7%, MVR = 6.5%, CABG + VR = 8.5%]. At the 12-month follow-up: CFQ-S [CABG = 6.6%, AVR = 7.5%, MVR = 15.1%, CABG + VR = 7.3%]; CFQ-F [CABG = 7.1%, AVR = 14.9%, MVR = 10.8%, CABG + VR = 9.8%]; PODI [CABG = 10.4%, AVR = 11.2%, MVR = 6.5%, CABG + VR = 4.9%]). No significant between-group effects were observed for the CFQ-S, CFQ-F, or the Hospital Anxiety and Depression Scale. ConclusionsFor clinicians, paying attention to patients' self-reported experiences of reduced cognitive function and symptoms of depression following cardiac surgery is important. Such reporting is an indication that interventions such as cognitive training or psychotherapy should be considered.

Validation of mitochondrial function measurements in permeabilized myocardial tissue from porcine left ventricular specimens with ischemia/reperfusion

Abstract Background Mitochondrial function is critical to myocardial ischemia/reperfusion injury and cardioprotection. The measurement of mitochondrial function in isolated mitochondria requires cardiac specimens of about 300 mg and is therefore only possible at the end of an animal experiment or during cardiosurgical interventions in humans. As an alternative, permeabilized myocardial tissue can be used for quantification of mitochondrial respiration in small myocardial specimens of about only 2-5 mg, which can be retrieved by sequential biopsies in animal experiments and during cardiac catheterization in humans. Whether or not mitochondrial dysfunction during ischemia/reperfusion is reflected to the same extent in saponin-permeabilized myocardial tissue specimens (PMT) and in isolated mitochondria is still unclear. Purpose We attempted to validate measurements of mitochondrial respiration from PMT by comparison to those from isolated mitochondria in left ventricular myocardium from anesthetized pigs undergoing coronary occlusion/reperfusion. Methods Göttingen open-chest, anesthetized minipigs (n=10) were subjected to 60 min distal left anterior descending artery occlusion and 180 min reperfusion. At the end of reperfusion, PMT and isolated mitochondria were prepared from remote and ischemic/reperfused myocardium. Baseline, adenosine diphosphate-stimulated complex I (without/with cytochrome c, to account for absence or presence of the outer mitochondrial membrane integrity) and complex IV respiration was measured at 37°C during magnetic stirring using a high-resolution respirometer. Mitochondrial respiration in PMT and isolated mitochondria was normalized to protein content and the content of the mitochondrial marker protein cytochrome c oxidase 4. Results Mitochondrial respiration measurements in PMT and isolated mitochondria correlated well (Figure 1A) and agreed well in Bland-Altman plot (Figure 1B). While baseline respiration in PMT was somewhat higher than that in isolated mitochondria (Figure 2A), mitochondrial dysfunction during ischemia/reperfusion was equally reflected in PMT and isolated mitochondria (Figure 2B & 2C). Complex IV respiration was not different between remote myocardium and ischemic/reperfused myocardium, independently of the preparation, indicating a comparable amount of viable mitochondria (Figure 2D). Conclusion Mitochondrial function measurements in PMT can substitute for that in isolated mitochondria to reflect their dysfunction in ischemia/reperfusion. Thus, mitoprotective strategies targeting ischemia/reperfusion injury in small tissue samples and also in human myocardial biopsies can be followed in PMT.Figure 1Figure 2

Mitochondrial respiration analysis in permeabilized porcine left ventricular and human right atrial specimens with ischemia-reperfusion.

Mitochondrial function is critical to myocardial ischemia-reperfusion injury and cardioprotection. The measurement of mitochondrial function in isolated mitochondria requires cardiac specimens of about 300 mg and is therefore only possible at the end of an animal experiment or during cardiosurgical interventions in humans. As an alternative, mitochondrial function can be measured in permeabilized myocardial tissue (PMT) specimens of about 2-5 mg, which are retrieved by sequential biopsies in animal experiments and during cardiac catheterization in humans. We attempted to validate measurements of mitochondrial respiration from PMT by comparison with those from isolated mitochondria of left ventricular myocardium from anesthetized pigs undergoing 60 min coronary occlusion and 180 min reperfusion. Mitochondrial respiration was normalized to the content of mitochondrial marker proteins [cytochrome-c oxidase 4 (COX4), citrate synthase, and manganese-dependent superoxide dismutase]. When normalized to COX4, mitochondrial respiration measurements in PMT and isolated mitochondria agreed well in Bland-Altman plots (bias score, -0.03 nmol/min/COX4; 95% confidence interval: 6.31 nmol/min/COX4 and -6.37 nmol/min/COX4) and correlated well (slope of 0.77 and Pearson's R of 0.87). Mitochondrial dysfunction by ischemia-reperfusion was equally reflected in PMT and isolated mitochondria (44 and 48% reduction of ADP-stimulated complex I respiration). Also in isolated human right atrial trabeculae, simulation of ischemia-reperfusion injury by exposure to 60 min hypoxia and 10 min reoxygenation reduced mitochondrial ADP-stimulated complex I respiration by 37% in PMT. In conclusion, mitochondrial function measurements in permeabilized cardiac tissue can substitute for that in isolated mitochondria to reflect mitochondrial dysfunction following ischemia-reperfusion.NEW & NOTEWORTHY Methods to quantify mitochondrial function in translationally relevant models and in human tissue are needed to improve the translation of cardioprotection to patients. Our present approach, using PMT instead of isolated mitochondria for the quantification of mitochondrial ischemia-reperfusion damage, provides a reference for further studies in translationally relevant large animal models and in human tissue, thus possibly improving the translation of cardioprotection to the benefit of patients with acute myocardial infarction.

Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery

BackgroundAfter pediatric cardiosurgical interventions, postoperative delirium can occur, which can be associated with undesirable consequences during and after the hospital stay. It is therefore important to avoid any factors causing delirium as far as possible. Electroencephalogram (EEG) monitoring can be used during anesthesia to individually adjust dosages of hypnotically acting drugs. It is necessary to gain knowledge about the relationship between intraoperative EEG and postoperative delirium in children.MethodsIn a dataset comprising 89 children (53 male, 36 female; median age: 0.99 (interquartile range: 0.51, 4.89) years) undergoing cardiac surgery involving use of a heart–lung machine, relationships between depth of anesthesia as measured by EEG (EEG index: Narcotrend Index (NI)), sevoflurane dosage, and body temperature were analyzed. A Cornell Assessment of Pediatric Delirium (CAP-D) score ≥ 9 indicated delirium.ResultsThe EEG could be used in patients of all age groups for patient monitoring during anesthesia. In the context of induced hypothermia, EEG monitoring supported individually adjusted sevoflurane dosing. The NI was significantly correlated with the body temperature; decreasing temperature was accompanied by a decreasing NI.A CAP-D score ≥ 9 was documented in 61 patients (68.5%); 28 patients (31.5%) had a CAP-D < 9. Delirious patients with an intubation time ≤ 24 h showed a moderate negative correlation between minimum NI (NImin) and CAP-D (rho = -0.41, 95% CI: -0.70 – -0.01, p = 0.046), i.e., CAP-D decreased with increasing NImin. In the analysis of all patients’ data, NImin and CAP-D showed a weak negative correlation (rho = -0.21, 95% CI: -0.40 – 0.01, p = 0.064). On average, the youngest patients had the highest CAP-D scores (p = 0.002). Patients with burst suppression / suppression EEG had a longer median intubation time in the intensive care unit than patients without such EEG (p = 0.023).There was no relationship between minimum temperature and CAP-D score.ConclusionsThe EEG can be used to individually adjust sevoflurane dosing during hypothermia. Of the patients extubated within 24 h and classified as delirious, patients with deeper levels of anesthesia had more severe delirium symptoms than patients with lighter levels of anesthesia.

ДИНАМИКА СОДЕРЖАНИЯ ФОСФОРА СЫВОРОТКИ КРОВИ У ПАЦИЕНТОВ ПРИ КАРДИОХИРУРГИЧЕСКИХ ОПЕРАЦИЯХ

Perioperative phosphorus monitoring should be used to prevent the complications after cardiac surgery and, as a result, to reduce the length of intensive care and hospital stay. The purpose of the study was to describe the change in blood phosphorus concentrations in open heart cardiopulmonary bypass surgery patients over time. Material and methods. A prospective non-randomized cohort study was performed. The change in phosphorus concentrations was assessed in 45 adult patients admitted to the Cardiac Surgery Department for an open heart cardiopulmonary bypass surgery. All patients gave venous blood samples at the following sampling time points: 1 – before the surgery; 2 – at 24 hours after the start of the surgery, 3 and 4 – at 48 hours and 72 hours, respectively. Phosphorus concentrations were assayed by photometry at the clinical biochemistry laboratory. Results. A phase change in phosphorus concentrations was observed during the postoperative period vs. preoperative period. Blood phosphorus levels showed statistically significant increase vs. baseline by 0,193, 0,2 and 0,34 mmol/L at 24-, 48- and 72-hours post-surgery, respectively. In 33.3% of patients, hypophosphataemia of less than 0,8 mmol/L was seen at 48 hours. The change in phosphorus concentrations over time in patients with and without creatine phosphate administration was studied. Intraoperative creatine phosphate therapy did not affect the postoperative phosphorus levels. Conclusions. In the postoperative period of cardiosurgical interventions using cardiopulmonary bypass, it is necessary to control the content of phosphorus in the blood serum and, if hypophosphatemia develops, to perform the introduction of phosphates.

Neurological, psychiatric and psychosocial consequences of cardiosurgical interventions in the conditions of artificial blood circulation and general approaches to their prevention

Cardiac surgery is a modern, effective, and promising direction of treatment of patients with severe cardiac pathology. An integral component of modern surgical interventions on the heart is artificial blood circulation, which is accompanied by several risks for the patient both during the operation and in the postoperative period. Despite the improvement of the surgical technique and the technological support of sur- gical interventions on the heart, the expansion of the spectrum of indications for operations and the increase in the average age of patients, the frequency of postoperative complications in CPH remains high, and the search for ways to reduce them is an extremely important task of modern medical science and practice. Among the postoperative complications of CVC, a significant place belongs to neurologi- cal disorders cerebral infarction, postoperative encephalopathy, and postoperative cognitive dysfunction. Also, negative clinical-psychopathological and psychosocial consequences occupy a significant place. Current scientific data on the pathogenesis, clinical and phenomenologi- cal features, and ways of treatment and prevention of complications of CHD are incomplete, contra dictory, and require additional research. Based on the above, a conclusion was made about the relevance of a number of important problems regarding the treatment and rehabilitation of patients with neurological consequences of surgical interventions on the heart, which require careful study and further resolution.

Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training.

Postoperative delirium (POD) and postoperative cognitive decline (POCD) can be observed after cardiosurgical interventions. Taken together, these postoperative neurocognitive disorders (PNCDs) contribute to increased morbidity and mortality. Preoperative risk factors of PNCD, such as decreased neuropsychometric performance or decreased cognitive daily activities, can be interpreted as reduced cognitive reserve. This study aims to build up cognitive reserves to protect against the development of PNCD through preoperative, home-based, cognitive training. The planned research project is a monocentric, two-arm randomized controlled intervention study involving 100 patients undergoing elective cardiac surgery with extracorporeal circulation. Patients will be assigned to a training group or control group. The intervention involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for ~40 min per day over a preoperative period of 2-3 weeks. The control group will receive neither cognitive training nor a placebo intervention. A detailed assessment of psychological functions will be performed ~2-3 weeks before the start of training, at the end of the training, during hospitalization, at discharge from the acute clinic, and 3 months after surgery. The primary objective of this study is to investigate the interventional effect of preoperative cognitive training on the incidence of POD during the stay in the acute clinic, the incidence of POCD at the time of discharge from the acute clinic, and 3 months after surgery. Secondary objectives are to determine the training effect on objective cognitive functions before the surgery and subjective cognitive functions, as well as health-related quality of life 3 months after surgery. Should it become evident that the use of our cognitive training can both reduce the incidence of POCD and POD and improve health-related quality of life, this intervention may be integrated into a standardized prehabilitation program.

A prognostic model for assessing the risk of psychosocial adaptation in patients who have undergone cardiosurgical interventions

The purpose of the study is to develop a prognostic model for assessing the risk of psychosocial maladjustment (PSM) in pa- tients who have undergone cardiosurgi- cal interventions (CI), taking into account a complex of surgical, neurological and psychopathological factors. 700 patients were examined after they underwent CI with an artificial blood circu- lation procedure: 86 patients with cerebral infarction, 217 patients with signs of post- operative encephalopathy and 504 patients with manifestations of cognitive dysfunction. For creating the model, non-linear modeling methods were used (multiple linear regres- sion analysis with a linearized model). Based on the research data, we pro- posed a complex model of PSM taking into account clinical, phenomenologi- cal and psychosocial factors. The model is based on a comprehensive assessment of three key vectors that can exert influence on the course of the postoperative period and the formation of PSM. The first vector (“surgical”) includes the main factors that characterize the seve- rity of the surgical intervention, and which have the greatest impact on the course of the postoperative period. The quantifica- tion of this vector is based on the following indicators: the duration, body temperature and blood pressure during surgery. The second vector (“neurological”) takes into account the main ischemic and neuro- logical complications in the postoperative period: cerebral infarction, postoperative encephalopathy, and postoperative cogni- tive dysfunction. The quantitative assess- ment of this vector is based on the results of the study of the patient’s cognitive function in the early postoperative period, namely, the indicators of the TMT-A and TMT-B tests, and the Stroop test. The third vector (“psychopathological”) includes three main psychopathological disorders: depression, anxiety, and aggres- siveness, and its quantification is based on the integral indicators of depression and anxiety according to the depression and anxiety scales of M. Hamilton and indicators of aggressiveness and hostility according to the Bass-Darkie test. The proposed model makes it pos- sible to obtain informative predictive indi- cators of PSM, which are close to the va- lues obtained by the diagnostic method of socio-psychological adaptation C. Rogers &amp; R. F. Dymond in the modification of A. K. Osnytsky

Structure of subjective manifestations of psychopathological symptoms in patients who have carried out cardiosurgical interventions in the conditions of art

The aim of the research was to study the structure of psychopathological symptoms in patients who underwent cardiac surgery (UCS) in the conditions of artificial circulation (AC), in the postoperative period, both in general and in terms of individual types of vascular and neurological pathology. Using the approaches of a structured clinical diagnostic interview with the assistance of a specially developed questionnaire, we clinically examined 700 patients who were treated at the Heart Institute of the Ministry of Health of Ukraine and who underwent UCS in the AC. Among the examined patients were 86 patients (12.3 %) with cerebral infarction (CI), 217 patients (31.0 %) patients with signs of postoperative encephalopathy and 504 patients (72.0 %) with manifestations of cognitive dysfunction. The study found that patients who underwent UCS with AC have a wide range of subjective manifestations of psychopathological symptoms. Such symptoms are represented by disorders of cognitive functioning, as well as affective (depressive and anxiety), asthenic and somatovegetative symptoms (in particular, dyssomnias and, to a lesser extent, appetite disorders). The highest prevalence of psychopathological symptoms was found in patients with CI, slightly less — in patients with postoperative encephalopathy, and the lowest — in patients with cognitive dysfunction. The results obtained should be taken into account when developing a system of specialized medical care and rehabilitation of this group of patients.

Enzymatic-metabolic support of oxidative homeostasis in patients with hypoxic-ischemic brain lesions in the stages of cardiosurgical interventions

To study the features of enzymatic and metabolic support of oxidative homeostasis in patients with hypoxic-ischemic brain lesions before and after cardiac surgery using artificial circulation we examined 38 patients, in particular: ischemic stroke — 14 people, encephalopathy — 15 people, severe cognitive dysfunction — 9 people ; diagnosis of neurological status was performed according to clinical protocols. Clinical and biochemical study was performed at the preoperative (3—5 days) and postoperative (5—7 days) stages: determined the content of superoxide dismutase, glutathione peroxidase, catalase in erythrocytes and α-tocopherol acetate in the serum of the blood, as well as the product cells: diene conjugates, metabolites of nitritanion in plasma. Variation statistics, probabilistic distribution of data with the subsequent estimation of reliability of results are applied; relative biochemical parameters were used: metabolic index, metabolic coefficient and metabolic effect for each. Standard methods using the program adapted to the “Excel” environment were used for calculations. The obtained data support the formation of patients with specific postoperative enzymatic-metabolic support of oxidative homeostasis, which should be considered as one of the triggers of hypoxic-ischemic brain lesions. In particular, at the level of the enzymatic chain of pro-, antioxidant protection and at the level of metabolic processes associated with peroxidation of phospholipids of cell membranes, a number of significant metabolic effects were revealed, which are generalized due to secondary oxidation products and NO‑dependent metabolites.

Кровозамінники з газотранспортною функцією: надії і реалії

Робота присвячена сучасному стану проблеми створення та клінічного використання кровозамінників із газотранспортною функцією. Описано технологічні напрямки розробок кровозамінників із газотранспортною функцією. Здійснено аналіз проведених досліджень кровозамінників на основі модифікованого гемоглобіну, перфторвуглеців, а також використання молекулярних, клітинних і нанотехнологій. Надано досвід широкого клінічного застосування кровозамінника з газотранспортною функцією на основі перфторвуглеців. Продемонстровані потенційні переваги використання кровозамінників із газотранспортною функцією порівняно з алогенною кров’ю.

Characteristics of cognitive functioning of patients who have undergone cardiosurgical interventions

The study of the state of cognitive functioning of patients who underwent Сardiо-Surgery Interventions (CSI) was studied to take into account the data obtained when creating rehabilitation programs for this category of patients. We examined 700 patients who were treated at the State Institution "Heart Institute of the Ministry of Health of Ukraine" after undergoing CSI with an artificial circulation procedure. First, the general state of cognitive functioning in the sample was analyzed. Then, in front of the examined patients, we selected a group of patients with manifestations of postoperative cognitive dysfunction (POCD), numbering 504 persons. Thus, in the second stage of the work, the indicators of patients in this group were compared with the indicators of patients who underwent CSI, without signs of CSI, the number of 196 persons taken from the same sample. As a result of the study, significant cognitive impairment was revealed in more than 70% of patients who underwent CSI. This manifested itself in the slowing down of mental processes and reduced switching of attention, manifestations of inhibition, rigidity of thinking, exhaustion, decreased speed and efficiency of memorization; in general, a total decrease in the speed and efficiency of cognitive processes, which is consistent with the data of modern scientific literature on the significant manifestations of cognitive deficits in the postoperative period after cardiac interventions. The answer to the question of identifying defensive factors inherent in a group of patients without signs of cognitive deficits will be obtained as a result of our further work. The identified patterns should be taken into account in the development of treatment, rehabilitation and prevention measures for patients who have suffered from CSI. Keywords: cardiac surgery, artificial blood circulation, postoperative cognitive dysfunction, cognitive functioning.

Hypoxic-ischemic brain injuries after cardiosurgical interventions: clinical options of somatogenic asthenic symptom complex in patients in the preoperative period

Annotation. The article presents the results of studying the symptomatology of different clinical variants of somatogenous asthenic symptom complex (SASC). The primary material of the study was a specially developed thematic map, the completion of which involved the implementation of clinical and anamnestic study and taking into account about 30 symptoms. Clinical and statistical methods were used: anamnestic quantitative analysis, variation statistics, probabilistic distribution of clinical signs with assessment of the reliability of the obtained results. It was found that in the structure of SASC the largest share belongs to the asthenic variant: is – 40.7%, while astheno-anxiety – 26.3%, astheno-subdepressive – 20.3%, and the smallest – dissomnic (12.7%). The symptomatic structure of SASC variants is characterized by the prevalence of the phenomena of physical and mental asthenia with symptoms of bodily synthesis, which allows to determine the most characteristic symptomatic complexes for cardiac surgery patients. The symptom complexes defined in research on each of variants of SASC allow to objectify at a preoperative stage a psychosomatic condition for maintenance of the integrated neurologic support of cardiosurgical patients.

Risk factors for the development of cerebrovascular disorders in patients after cardiosurgical interventions

The article is dedicated to the study the risk factors of cerebrovascular disorders development after cardiosurgical interventions. It was shown that the most significant factors are: arterial hypertension — 100.0 %, hypercholesterolemia — 100.0 %, multiple lesions of the brachiocephalic arteries (73.3 %) and arteries of the lower extremities (26.7 %), type II diabetes mellitus (53.3 %) and renal failure (40 %), the presence of bad habits associated with chronic intoxication (46.7 %), psychoemotional overstrain (76.7 %), the impact of surgical techniques interventions and the presence of chronic cerebrovascular insufficiency in patients which sent to the operation. A complete laboratory-instrumental and neurological preoperative examination, an adequate assessment of the cerebral hemodynamics system creates the basis for reducing postoperative cerebral disorders and the basis for the development of a complex of preventive measures. Key words: risk factors, cardiosurgical interventions, cerebrovascular disorders

Case of diagnosis of late postpericardiotomy syndrome after aortocoronal and mammary coronary bypass

Postpericardiotomy syndrome (PCTS) develops after cardiosurgical operations as part of the non-specific systemic inflammatory responses syndrome of the body (SIRS) and manifests signs of general intoxication and symptoms of involvement in the autoimmune inflammatory process of pulmonary pleurae and/or pericardial layer to form efflux in the pleural and/or pericardial cavities. PCTS is not a rare pathological condition and often accompanies heart surgeries, especially those which are carried out under cardiopulmonary bypass. However, it can occur in the guise of lung and pleura diseases, cardiac decompensation and other complications of cardiological diseases and cardiosurgical interventions. In the light of the specificity of the therapy of this syndrome, its correct and timely diagnosis is intended to alleviate the already unsatisfactory condition of the patient who has undergone heart surgery and his postoperative prognosis. Although this pathology was described in the middle of the last century, its methods of treatment are still under discussion, in particular the effectiveness of glucocorticosteroids and colchicine is compared and the use of the latter for the prevention of PCTS is considered. This paper presents the case history of PCTS tolerant to hormone therapy and managed with colchicine.

Cardiosurgical endovascular intervention during pregnancy

Objective. To share the experience of endovascular interventions in pregnant women and women in labor, gained by national team “obstetric cardiology”. Materials and methods. The algorithm of medical support was presented, including the cases of cardiosurgical interventions performance , for pregnant women with critically severe pathology of the heart, which was based on actual recommendations and own experience. Into the clinic of Amosov National Institute of Cardiovascular Surgery during 6.5 yrs (12.2013 - 05.2020) 145 women-patients were admitted to hospital, in 79 of them cardiosurgical intervention was done. Endovascular cardiosurgical operations were performed in 36 patients, and the hybrid - in 2. Urgent and emergency endovascular interventions were performed in 17 women-patients with various terms of pregnancy (15 - 35 weeks) and in 2 women in labor. Conditionally-elective cardiosurgical interventions were performed in 17 women-patients on various terms of pregnancy (as a rule, in II trimester) and in 2 women in labor. In 34 patients the interventions were performed with fetus in utero. Early and late maternal mortality was absent. One «programmed» loss of the fetus have occurred on 12-th week of pregnancy with the inborn heart failure. Modern views on impact of ionized radiation and contrast substances on fetus were presented, and the methods of lowering of their potential harm. Conclusion. There was trusted, that while applying strict indications for performance of endovascular interventions during pregnancy, these methods of diagnosis and treatment are more secure in comparison with «open» operative interventions and may be performed under supervision of experienced multidisciplinary team, taking into account the pregnancy term and the fetus defense.

Takotsubo syndrome after mitral valve replacement and defibrillation

The article describes the case of Takotsubo syndrome, which arose in a 71-year-old female patient after a mitral heart valve replacement , performed due to its severe (3rd degree) insufficiency of non-rheumatic genesis. This pathology is quite rare. Questions of its etiology and pathogenesis remain controversial. A special feature of this case is the development of reversible left ventricular dysfunction in the early postoperative period after mitral valve replacement. The reduction of the left ventricular ejection fraction to 25% with hyperkinesia of its basal parts with subsequent recovery of the ejection fraction to 56% 3 weeks after the onset of the disease was observed. There were also electrocardiographic changes simulating acute circular myocardial infarction with the absence of hemodynamically significant lesions of the coronary arteries. The patient had risk factors for this syndrome (age, female gender, stress situation, surgical intervention, administration of dobutamine and fluoroquinolones). For the reasons given above, the presence of Takotsubo syndrome was suspected. This case demonstrates the possibility of developing takotsubo syndrome after cardiosurgical interventions and defibrillation.